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Bariatric Diet:
What & How to Eat

The right bariatric diet and
proper bariatric eating techniques can mean the difference
between success and failure. They will help you avoid
complications and maximize short and long-term weight loss.

Conventional wisdom may tell you, “You’re getting bariatric
surgery soon, so now’s the time to live it up!” But you must
have the complete opposite mentality.

From the moment you begin to seriously consider weight loss
surgery, your diet habits should change forever. Consider the
months leading up to surgery as a test. You are training yourself to
have discipline with food and learning the motivation it will take to
reach your goals.

The right bariatric
surgeon will help. Part of the
process of choosing a good doctor is learning about the dietitian or
nutritionist that they partner with or have on staff. The dietitian
will talk with you about your diet history and will help you understand
what kind of eater you are.

In addition to pointing you towards the bariatric treatment
that will mold best to your habits, they will set you on an appropriate
pre-bariatric surgery diet.

Their involvement is also important from a financial
perspective. Many bariatric
insurance providers require that you go
through a medically-supervised weight loss program before they approve
your surgery.

"...NO one last big unhealthy meal before surgery."

Your pre-surgery bariatric diet will most likely be
high-protein and low-carbohydrate with plenty of fluids. For the two
weeks leading
up to surgery, you’re bariatric diet will most likely be a liquid one
and your
daily calories will be at or below 1,000. To ensure you’re getting the
right nutrients, your dietitian may also prescribe bariatric
vitamins.

A high-protein/low-carbohydrate bariatric diet is important
for 3 big
reasons…

Reduces bleeding

Promotes healing

Shrinks your liver – an enlarged liver can make surgery
more difficult by blocking the surgeon’s view and increase the risk of
your liver being damaged during surgery.2

We’re sorry to say that this means no
“one last big unhealthy meal” before surgery.

Bariatric
Diet Immediately After Surgery

YOUR Weight Loss Journey

Your surgeon-recommended dietitian or nutritionist will also
have you on a detailed bariatric surgery diet plan for the first
several weeks after surgery. Following their advice exactly will
promote healing and start you on your permanent (and more enjoyable)
bariatric diet while minimizing negative side-effects…

You’ll only be able to have liquids for the first couple of
days following surgery. Hospital meals will probably include broth,
water and possibly juice, although you may find that juice upsets your
stomach at first.

Your liquid bariatric diet may only be an ounce at first. Yes,
an ounce! That’s about the equivalent of two tablespoons.

Blend It!

Starting around week 2, your blender will become an integral part of your meal preparation. Even after you're completely healed, smoothies and pureed meals will compliment your bariatric diet well and are a great place to include your extra protein if necessary.

If you don't have a great blender already, we strongly recommend investing in one.

We like the Magic Bullet Set(aff - pictured below). In addition to whipping, blending or grinding quickly and thoroughly, it makes clean-up easy and includes everything you'll need to serve your creation or take it to go.

Adding powdered protein to your bariatric diet will follow
your
liquid-only diet for a week or two, but the mixture should still be
water-like. Certain soups will probably be okay as long as they don’t
have any solids in them. During the first week, your doctor will most
likely recommend that you sip a few ounces of your liquid meals every
hour or so.

From the 2nd through the 6th weeks your liquid meals will
get thicker and thicker (but still completely pureed with no small bits
remaining). Solid foods will be out of the question. Eating 4 to 5
three ounce meals a day is normal. Your tiny stomach won’t be able to
hold much, so expect to feel full very quickly. Foods appropriate for
this stage include cream soups and yogurt-based smoothies.

As soon as possible, your doctor will have you eating solid
foods which will make you feel full sooner. This could happen
as soon as the fourth week, although the average patient gets there
between 6 and 8 weeks. At that point, your bariatric diet
will consist of 3 four-ounce “normal” meals per day.

Introduce foods back slowly to figure out which foods your
system can and can’t tolerate. Anything too fibrous, such as raw
vegetables, may be too much for your system to handle at first. You’ll
need to cook everything well and chew it thoroughly before swallowing.

After 6 to 8 weeks or so, you’ll be fully transitioned into
your new
permanent bariatric diet.

IMPORTANT:
For the first few months following surgery you need
to be
very mindful of avoiding dehydration. Your body will need about 8 cups
(1/2 gallon!) per day.

Not getting enough can lead to nausea and
persistent vomiting which, in turn, can lead to vitamin deficiencies
and put you back in the hospital.

Long-term
Bariatric Diet - What NOT
to Eat

Patient Advice

Be sure to read this page all the way to the bottom - there's some valuable advice from other patients that you don't want to miss.

And while you're reading it, be sure to share your own experiences!

First, let’s talk about what not
to eat.

You’ll notice the term “trigger foods” throughout our site.
This refers
to foods that upset your digestive system (cause digestive issues such
as difficulty swallowing, vomiting, diarrhea or constipation).

As you transition into your long-term bariatric diet, certain
foods will need to be put on the back burner until your stomach is
ready for them while others may upset your stomach forever. You may be
able to avoid the trigger by reducing their amounts, but there is also
the chance you will need to give the food up altogether.

According to the American Society for Metabolic and Bariatric
Surgery1, following are the
foods may or
may not be okay depending on your body and the type of surgery you
choose…

Still have questions or concerns about
this page's topic?

If you finish reading this page and still have questions or concerns, our weight loss surgery community will be happy to help.

When possible, avoid anything that was modified by humans in
any way. A
good rule of thumb can be applied by reading the label… if there are
more than 3 to 5 ingredients or if there are any ingredients that you
can’t pronounce, don’t buy it.

2. Protein
first

Protein is one of the most important nutrients for your body,
and you
need a lot of it in order to stay healthy… up to 80 grams a day.

With
your old stomach, this was no problem. But now that your stomach is
down to the size of a golf ball, 80 grams is a big percentage of the
available space.

Your body’s going to do all it can to get the adequate amount
of protein, so if you’re not
eating
enough your body will begin to break down muscle. This can cause you to
feel nauseous, irritable, weak and tired. If lack of protein intake
goes on too long it can ultimately cause general swelling, hair loss
and skin problems, worsen your immune system and increase your risk of
infection.

So eat you protein first.

It can be found in many foods, including meat, fish, soy and
dairy products, legumes and nuts. When you’re picking your protein, be
mindful of fat content as many protein sources contain ample amounts of
it. Always opt for the lean or low-fat option.

If you’re having a tough time getting enough, it may be
necessary to
supplement your bariatric diet either every day or as needed. For
example, a
daily supplement can be taken in the form of a pill or powder, or you
can make yourself a protein shake at the end of a low-protein day.

3. Keep
your blood sugar stable

Avoid simple carbohydrates. Foods with simple carbs include
white
bread, potatoes, white rice, corn, peas and anything that is obviously
full of sugar like candy, ice cream or donuts.

Eat good carbs in small portions (along with your high
amounts of
protein), including vegetables, apples and the “brown foods” like
whole-grain bread and brown rice. In addition to being good for your
blood sugar level, they are often high in fiber which makes you full
faster and helps to regulate your bowel movements.

4. Drink
the right amount of water at the right
times

Not just water!

It's important that you remain hydrated after weight loss surgery... you must drink FLUIDS (preferably, low calorie ones such as unsweetened, caffeine-free herbal tea) but not just water.

If you only drink water, you may develop electrolyte abnormalities such as water intoxication syndrome.

Talk with your team for recommendations specific to you, but usually no more than half of your fluids should be water.

It is also important that you drink a lot of fluids… between 48
and 64
ounces per day. That’s equal to about 8 cups or 1/2 a gallon. This may
be tough to do considering the size of your new stomach.

To make things more difficult, you can’t drink with your meals
and need to wait at least an hour after you eat before drinking
anything. If you don’t, the liquids will quickly flush the food through
your stomach. This can affect digestion, make you feel hungry and lead
to weight
gain after bariatric surgery.

To meet your liquid intake goals, keep some liquids next to you
at all
times and sip a little every 15 to 20 minutes outside of meal time.
Stay on track by getting a special container, measuring out your daily
amount of fluids every
morning and putting it in the fridge (or on the counter if you prefer
your liquids at room temperature).

Spread your consumption throughout the
day so that the container is empty before you go to bed.

5.
Don’t snack

Snacking between meals is the quickest way to halt your weight
loss
progress and to gain your weight back after you hit the low point.

Don’t do it.

By far the best way to keep you honest is to keep a good free diet journal. Plan all of your meals ahead of time. When you
go to the
grocery store, only buy the foods that you have planned. Then only eat
what you’ve planned, when you’ve planned (more on this important tip
further down the page).

While it's very technical and can be a tough read, we
highly recommend that you print and review the Bariatric Surgery Nutritional Guidelines
from the American Society for Metabolic and Bariatric Surgery (ASMBS).
In addition to containing the most recent bariatric diet
research for your own knowledge, it's also a great reference to ensure
that your dietitian or nutritionist is up-to-date.

Procedure-Specific Bariatric Diet Advice

The advice throughout this page - both above and below this section - applies to everyone, regardless of procedure. However, there are certain precautions you'll need to take depending on which procedure you have.

Click the following to jump to your procedure or scroll down review them all:

Gastric Sleeve Diet

Your smaller stomach after gastric sleeve surgery will lead to a couple of important changes in your diet:

You will feel full much sooner than you did before

If you eat too quickly, you may have difficulty swallowing. This is the result of food backing up into the esophagus after the stomach pouch has been filled. To avoid this, chew your food thoroughly, eat slowly and eat foods that are more easily digested. This should get better as your pouch stretches over time.

Diarrhea is relatively common after gastric sleeve surgery. Eating a pre-planned gastric sleeve diet will usually get things back to normal, although some patients find that the diarrhea is caused by lactose intolerance (not necessarily caused by surgery, but the new stomach can make lactose intolerance symptoms more prevalent). If that’s the case, you’ll need to avoid dairy products.

Gastric Bypass Diet

Just like gastric sleeve surgery, you’ll feel full sooner after eating due to the smaller size of your stomach. You may also lose certain food cravings due to hormonal changes resulting from the surgery.

Most gastric bypass patients (about 80%) will experience dumping syndrome when they eat the wrong foods. Conveniently, the wrong foods are the unhealthy ones, so while dumping syndrome symptoms are unpleasant, they help you keep your gastric bypass diet in check.

While diarrhea does occur for some patients (see Gastric Sleeve Diet section above for recommendations), constipation is more common after gastric bypass and usually means that you need to drink more water.

Due to the malabsorptive component of gastric bypass surgery, your doctors will insist that you take bariatric vitamins for the rest of your life to avoid extremely dangerous vitamin deficiencies.

Lap-Band Diet

The gastric band reduces the amount of food you can eat before feeling full by creating a small stomach "pouch" on the upper portion of your stomach. As a result, you should follow the same precautions as those listed in the gastric sleeve section above.

Unlike the other procedures, the rest of your stomach will still be intact below your band. As a result, drinking water 30 minutes before through 30 minutes after meals will make it even easier to "flush" food through your smaller stomach pouch causing you to eat more than you should.

Duodenal Switch Diet

Duodenal switch surgery is so effective due to both reducing the size of the stomach AND through limiting the amount of food that your system absorbs. To offset this lack of absorption, you'll need to take several different vitamins and supplements every day or risk developing serious, life-threatening vitamin deficiency.

Supplements will likely include:

Multi-vitamin/mineral supplement

Calcium

Iron

Fat soluble vitamins (A, D, E, and K) in a 'dry' form

Probiotics (beneficial bacterium found in the intestinal tract)

Routine tests are essential to make sure your body is getting the nutrients it needs.

YOUR Weight Loss Journey

The following 12 tips will keep you moving toward your goal.
We recommend that you either print this list or write it down and keep
it in a place you go all of the time such as your journal. Read it
frequently or, at a minimum, when you go through rough patches…

Use a free online diet journal to plan and record your meals –
if you have to choose two things on this list, this is one of them. As
mentioned above, use it to...

Plan all of your meals ahead of time

Act as your guide through the grocery store, take it with
you (or
print your list)
and only buy the foods that you have planned

Set a
realistic goal weight. Your bariatric surgeon will
work with you
to make sure your goals are realistic based on the bariatric surgery
procedure you choose. See our Types
of Bariatric Surgery page to learn
what the average patient loses for each procedure.

Set monthly
goals, document your progress and plan a reward
for
yourself each time you hit them. This is another great use
for your
food journal.

Rewards could include treating yourself to a massage or
spa day (or get your partner to commit to giving you a massage if you
don’t want to spend the money), throwing a little party, having a
barbeque or scheduling a weekend trip away. And be disciplined. Only
give yourself the reward if you hit your goals.
Appropriate goals include…

Since healthier foods tend to cost more, don’t be afraid
to shop in
bulk and freeze the extras.

Measure your
meals with a scale… don’t
guesstimate. Overweight people under-estimate
their calorie content per meal by as much as 22%.5
Get your
bariatric diet down to a science – your body will thank you for it.

Use small
plates and small utensils. At only 4 ounces per meal,
using your old plates could lead you to add more just because the new
portion sizes feel so tiny in comparison. Smaller plates and utensils
will help train your mind to feel okay with the smaller amounts.

Cut your
meals up in to small
pieces and chew them thoroughly. By doing so, your new
meal sizes will feel much more satisfying.

“I used to eat and eat
without really enjoying the
food. Sure, I liked it. But it had become habit to eat as much as I
could as quickly as I could. After bariatric surgery, for the first
time in my life I feel like I really enjoy the food. I eat slowly and
savor the taste of every single atom.”

Anonymous Weight Loss Surgery
Patient

Identify and
address emotional eating as soon as it arises. Most won’t
have a problem with emotional eating after bariatric surgery, but some
will.

The best way is to keep and follow (you guessed it!) offline or online
food
journals. If you find yourself cheating, make a note of
exactly how you
felt and what you ate. What happened before you started eating? Did you
have a fight? Did you remember something that made you depressed?

Don’t be afraid to ask for help… your dietitian or nutritionist and
psychologist see this kind of issue often and can help you work through
it. Your support group is also a great place to talk through your
problems and learn new ways to overcome them.

Some patients also like to choose a place or a room in their home that
they’re “not allowed” to have food, such as the bedroom or porch. Use
this room as a safe haven and retreat there when having a rough food
day..

Watch as
little regular TV as possible. Research has shown that the
more you watch, the more likely you’ll be to get away from your
bariatric diet,
but not for the reasons you probably think.6

In actuality, media and advertising are the main culprits.

Can you remember a time when you were casually watching television, not
even the slightest thought of food floating through your mind… and out
of no where came this giant, juicy Big-Mac with glistening fries and a
sweet soda? Before you knew what hit you, you were in the
car, on the way to satisfy a media-induced craving… right?
You’re not alone!

This can be a tough issue since TV is such a big part of all our lives,
but there are numerous activities that can be just as fun… including
ones that involve the TV. Here are some ideas along with our picks for the companies that can make it happen...

Use a digital video recorder (DVR) to record the shows
you like and
fast-forward through the commercials. If you don't have a DVR at home, there's a good chance that your local cable company will install one for an additional fee.

"View this as an excuse to improve your mind and your
relationships."

Read more books and play games – video games, card games
and board games are fun by yourself, with a family member or with a
friend. Amazon.com is a great place to get book and game ideas. We challenge you to think of a book they don't have in stock (new or used).

It’s easy to say, “I
won’t be tempted by the media… the high percentages from the
research apply to other people.”

But why risk it? In addition to
lowering your chances of losing focus, the other activities mentioned
above can be more mentally stimulating and are a great excuse to spend
quality time with those you care about. If nothing else, view this as
an excuse to improve your mind and your relationships!

Exercise
every day. In addition to boosting your
metabolism which keeps your body burning those calories, weight loss surgery exercise is a great
way to take your mind off of your hunger and to curb your appetite.

It has also been proven to help prevent depression, lower bad
cholesterol, increase good cholesterol, improve libido and improve
insulin control. Plus, research has proven that it will make you live longer!7

YOUR Weight Loss Journey

Tough meat
can get stuck and cause vomiting. Meat is
very
important to
your bariatric diet for the protein that it contains, but you may need
to cook it
in a way that keeps it soft, choose more tender cuts or chew it more
thoroughly before swallowing.

Soda is generally discouraged but may be acceptable IN MODERATION and only if enjoyed between meals (drinking any liquids during meals will flush your food through your smaller stomach and likely cause you to eat more than you should). See this patient-surgeon dialogue about Soda Safety for more information.

Alcohol
& Your Bariatric Diet

Many types
of bariatric surgery alter
the way your digestive system works by either removing part of your
stomach, rearranging things or both. As a result, alcohol will have a
much different effect on your system
after
surgery.

Here are the reasons why:

Your stomach no longer metabolizes the alcohol as well
(because part of
it is gone or bypassed).

Most of the alcohol absorption takes place in the small
intestines.
Rather than being partially absorbed by the stomach, after bariatric
surgery most of the alcohol passes quickly into the small
intestines.

The longer the food stays in the stomach, the less
drunk
you get. This is why you get intoxicated faster on an empty stomach…
the alcohol is not slowed down by any food and passes more quickly into
the small intestines.

With a smaller and/or bypassed stomach, the
alcohol passes through much faster. To make matters worse, you’re not
supposed to drink anything during or an hour after meals. As a result,
when you drink alcohol you’re always drinking on an (at least
partially) empty stomach.

With procedures that bypass the connection between your
stomach and
small intestines, there is no regulation of fluids flowing into your
small intestine. This is yet another reason alcohol gets there so fast.8

Several issues can arise if you decide to drink alcohol.

First,
the sugar and carbohydrates found in alcoholic beverages can derail
your daily goals, cause your blood sugar levels to get away from you
and cause you to gain back weight.

There are also alcohol-related
health issues that you’ll be at greater risk for after surgery (some of
which can lead to death), including…

Finally, with alcohol in you, you are much more likely to give
in to food cravings. In addition, you open yourself up to other
problems such as drunk driving or behaving in a way that you may regret
the next day.

If it all possible, keep things simple… keep alcohol out of
your bariatric diet after surgery.

If you absolutely must drink, always be on the safe side…

Don’t drink any alcohol for at least a few months after
surgery.

Don’t
drive after drinking anything (even after small amounts).

Eat a meal
before you drink (remember to wait at least an hour after eating).

Avoid alcoholic beverages with additional sugars and
carbohydrates
(such as
some mixed drinks and certain kinds of beer).

Your story will appear on a Web page exactly the way you enter it here. You can wrap a word in square brackets to make it appear bold. For example [my story] would show as my story on the Web page containing your story.

TIP: Since most people scan Web pages, include your best thoughts in your first paragraph.

Do you have a picture to add? It can be anything relating to your story, such as your favorite meal, a before or after photo or something that helped you with your decision like your surgeon, a chart/picture/diagram relating to your chosen procedure, friends and family, etc.

University of Minnesota. Couch potatoes or french fries: Are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents. Available at: http://www.epi.umn.edu/research/eat/ab_couchpotato.php. Accessed: October 15, 2009.

Disclaimer: The information contained in this web site is provided for general informational purposes only. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional.
Read More

University of Minnesota. Couch potatoes or french fries: Are sedentary behaviors associated with body mass index, physical activity, and dietary behaviors among adolescents. Available at: http://www.epi.umn.edu/research/eat/ab_couchpotato.php. Accessed: October 15, 2009.

Disclaimer: The information contained in this web site is provided for general informational purposes only. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional.
Read More